Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(03): e334-e338
DOI: 10.1055/s-0041-1730457
Original Research

Zenker Diverticulum: Does Size Correlate with Preoperative Symptoms?

Jhon F. Martinez-Paredes 
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Razan Alfakir 
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Jan L. Kasperbauer 
2   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Amy Rutt 
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life.

Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD.

Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1–3 cm), and large (> 3 cm).

Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04).

Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Keywords

zenker diverticulum - pharyngeal pouch - esophageal diverticulum - dysphagia - dysphonia


Publication History

Received: 17 November 2020

Accepted: 14 February 2021

Article published online:
26 October 2021

© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Cook IJ, Blumbergs P, Cash K, Jamieson GG, Shearman DJ. Structural abnormalities of the cricopharyngeus muscle in patients with pharyngeal (Zenker's) diverticulum. J Gastroenterol Hepatol 1992; 7 (06) 556-562
    CrossrefPubMedGoogle Scholar
  • 2 Lerut T, Coosemans W, Decaluwé H. et al. Zenker's diverticulum. Multimedia manual of cardiothoracic surgery: MMCTS. 2009;2009(224):mmcts.2007.002881.
    Google Scholar
  • 3 Visser LJ, Hardillo JA, Monserez DA, Wieringa MH, Baatenburg de Jong RJ. Zenker's diverticulum: Rotterdam experience. Eur Arch Otorhinolaryngol 2016; 273 (09) 2755-2763
    CrossrefPubMedGoogle Scholar
  • 4 Morales-Divo C, Jecker P, Lippert B, Mann WJ. [Extraesophageal reflux in patients suffering from Zenker's diverticulum]. HNO 2007; 55 (07) 546-550
    PubMedGoogle Scholar
  • 5 Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J 2001; 77 (910) 506-511
    CrossrefPubMedGoogle Scholar
  • 6 Nehring P, Krasnodębski IW. Zenker's diverticulum: aetiopathogenesis, symptoms and diagnosis. Comparison of operative methods. Prz Gastroenterol 2013; 8 (05) 284-289
    PubMedGoogle Scholar
  • 7 van Overbeek JJ. Meditation on the pathogenesis of hypopharyngeal (Zenker's) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol 1994; 103 (03) 178-185
    CrossrefPubMedGoogle Scholar
  • 8 Ferreira LE, Simmons DT, Baron TH. Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 2008; 21 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 9 Bergeron JL, Long JL, Chhetri DK. Dysphagia characteristics in Zenker's diverticulum. Otolaryngol Head Neck Surg 2013; 148 (02) 223-228
    CrossrefPubMedGoogle Scholar
  • 10 Palmer AD, Herrington HC, Rad IC, Cohen JI. Dysphagia after endoscopic repair of Zenker's diverticulum. Laryngoscope 2007; 117 (04) 617-622
    CrossrefPubMedGoogle Scholar
  • 11 Shah RN, Slaughter KA, Fedore LW, Huang BY, Deal AM, Buckmire RA. Does residual wall size or technique matter in the treatment of Zenker's diverticulum?. Laryngoscope 2016; 126 (11) 2475-2479
    CrossrefPubMedGoogle Scholar
  • 12 Greene CL, McFadden PM, Oh DS, Chang EJ, Hagen JA. Long-Term Outcome of the Treatment of Zenker's Diverticulum. Ann Thorac Surg 2015; 100 (03) 975-978
    CrossrefPubMedGoogle Scholar
  • 13 Périé S, Dernis HP, Monceaux G, Angelard B, St Guily JL. The “sign of the rising tide” during swallowing fiberoscopy: a specific manifestation of Zenker's diverticulum. Ann Otol Rhinol Laryngol 1999; 108 (03) 296-299
    CrossrefPubMedGoogle Scholar
  • 14 Cote DN, Miller RH. The association of gastroesophageal reflux and otolaryngologic disorders. Compr Ther 1995; 21 (02) 80-84
    PubMedGoogle Scholar
  • 15 Sen P, Kumar G, Bhattacharyya AK. Pharyngeal pouch: associations and complications. Eur Arch Otorhinolaryngol 2006; 263 (05) 463-468
    CrossrefPubMedGoogle Scholar
  • 16 Beard K, Swanström LL. Zenker's diverticulum: flexible versus rigid repair. J Thorac Dis 2017; 9 (Suppl. 02) S154-S162
    CrossrefPubMedGoogle Scholar
  • 17 Schoeff S, Freeman M, Daniero J. Voice Outcomes in Surgical Repair of Zenker's Diverticulum. Dysphagia 2017; 32 (05) 678-682
    CrossrefPubMedGoogle Scholar
  • 18 Allen BC, Baker ME, Falk GW. Role of barium esophagography in evaluating dysphagia. Cleve Clin J Med 2009; 76 (02) 105-111
    CrossrefPubMedGoogle Scholar